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What is Medicare Extra Help and who qualifies for it now?
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TL;DR
- Medicare Extra Help (Part D Low-Income Subsidy) reduces prescription drug costs for eligible beneficiaries.
- It can lower Part D premiums and deductibles to $0, cap generic drugs at $5.10 and brand-name drugs at $12.65, and eliminate late enrollment penalties.
- Automatic qualification is available for those receiving full Medicaid, certain Medicare Savings Program benefits, or SSI.
- Other beneficiaries may qualify based on annual income limits of $23,940 (individual) or $32,460 (married couple) and resource limits of $18,090 (individual) or $36,100 (married couple) for 2026.
- Resources considered include savings, stocks, bonds, and retirement accounts, but not primary homes, vehicles, or personal possessions.
- Extra Help specifically targets Part D costs, while Medigap policies help with Original Medicare (Parts A & B) out-of-pocket expenses.
- Medigap policies generally do not include prescription drug coverage.
- It is advisable to check eligibility for Extra Help even if income or resources are close to the limits.